1. The anterior retroperitoneal approach involves making a curved or short oblique incision over the rectus muscle and ligating the superficial and inferior epigastric vessels. 2. The parietal peritoneum is reflected from the lateral abdominal wall, exposing the psoas muscle, genitofemoral nerve, ureter, testicular vessels, and superior hypogastric plexus. 3. The psoas muscle is elevated off the vertebrae of interest and retracted laterally to expose the anterolateral prevertebral region for surgery.

1. ANTERIOR RETROPERITONEAL
APPROACH
1) Patient supine, curved or short oblique incision over rectus
muscle
2) Ligate superficial and inferior epigastric vessels
3) Reflect parietal peritoneum from lateral abdominal wall
4) Identify psoas with overlying genito femoral nerve, ureter
crossing common iliac artery with testicular vessels, and
superior hypogastric plexus over sacral promontory

2. ANTERIOR RETROPERITONEAL
APPROACH
• Elevate psoas m. off vertebrae of interest and retract laterally
• Ligate ascending lumbar vein if necessary
5) May retract iliac vessels medially above L5 and laterally
below

3. Incision for anterior retroperitoneal approach.

5. POSTERIOR LAMELA
OF RECTUS SHEATH
PERITONEUM
ANTERIOR LAMELLA
OF RECTUS SHEATH
RECTUS ABDOMINIS MUSCLE
The rectal sheath is divided to allow retraction
or division of the lateral rectus muscle.

7. HEAD FEET
PSOAS MUSCLE
PERITONEAL
STRUCTURES
4th LUMBAR
ARTERY AND
The peritoneal structures and the psoas muscle are retracted,
exposing the anterolateral prevertebral region.
VEIN
SACRAL
PROMONTORY
INTERNAL
ILIAC ARTERY
ASCENDING
LUMBAR VEIN
INTERVERTEBRAL
DISKS